http://www.stltoday.com/stltoday/news/stories.nsf/stlouiscitycounty/story/A6B8ADF657D0E5DE862572DC0011F960?OpenDocument Midwives bill slips through Missouri Legislature By Matthew Franck POST-DISPATCH JEFFERSON CITY BUREAU 05/15/2007 JEFFERSON CITY A bit of trickery and an obscure Greek term have delivered to the governor something that 20 years of lobbying has not a bill that loosens restrictions on the practice of midwifery. But the questionable methods used to pass the legislation have stripped Sen. John Loudon, R-Chesterfield, of his duties as chairman of an influential committee. And Senate leaders say they may take the rare step of trying to nix the legislation before it becomes law. Loudon tucked the midwife provision into a 123-page health insurance bill that was approved by the House and Senate last week. Even those who bothered to read the entire bill would have been unlikely to catch the midwife measure, since the word midwife never appears. Instead, the bill authorizes people to provide birthing services if they hold "tocological certification." According to medical dictionaries, "tocology" is the science of obstetrics and midwifery, derived from the Greek word "tokos," meaning childbirth. Loudon on Monday stood by his tactics. "It shouldn't have been a surprise to anyone that I would use any means possible to get this done," he said. Under current law, midwifery is limited to certified nurse midwives, who must work in partnership with doctors. A midwife helps with prenatal care and childbirth, often assisting with deliveries in homes. The new legislation would significantly reduce the requirements, allowing prospective midwives to get certified by a private entity, even if they lack formal medical or nursing training. Most lawmakers learned Monday that they had unwittingly approved the measure. Even some supporters of looser regulations were livid. Senate President Pro Tem Mike Gibbons punished Loudon's actions Monday, removing him as chairman of the Senate Small Business, Insurance and Industrial Relations Committee. Gibbons, R-Kirkwood, said he may make the move permanent, pending an investigation. Loudon said those who didn't catch the midwife measure have only themselves to blame: "The fact that it was missed was more on them than on me." Loudon has fought to pass midwife legislation for years but has hit a brick wall. Supporters of midwife legislation say women should have the freedom to chose the birthing option with which they're most comfortable. Critics raise safety concerns, saying midwives may lack the training to deal with complications. Loudon said he saw a way to sidestep the impasse by attaching the midwife measure to a bill on health insurance. As the Senate handler of the bill, Loudon offered a new version on the Senate floor late Thursday. As he introduced the bill, he said nothing of the midwife provision, describing the broader bill as similar to a version previously approved by the Senate. "He was purposely deceptive," said Sen. Chuck Graham, D-Columbia, a lead opponent of the midwife measure. The bill cleared by a 31-0 vote. A day later, the House gave its approval, sending the bill to Gov. Matt Blunt. The governor is reviewing the bill, according to a spokesman. Gibbons said the broader insurance bill which seeks to increase private health coverage for the uninsured by expanding tax incentives for those who purchase their own insurance is too important to kill over the midwife issue. Instead, he said, lawmakers may work to pass a provision to negate the midwife measure. But such a move could be difficult, given that the legislative session ends Friday. The exact implications of the midwife measure were unclear Monday. Lawmakers disagree over how many midwives might be able to practice legally under the provision. Only a few certified nurse midwives now practice in the state, but many more lay midwives those without medical or nursing training are believed to be working in violation of Missouri law. Midwife advocates say they would have preferred passage of a broader midwife bill, providing greater detail about the training requirements. "But this bill is a whole lot better than leaving midwives as felons," said Mary Ueland of the midwife group Show Me Freedom in Health Care. Aside from using the term "tocological," the measure indirectly describes the requirements needed to become a midwife. Under the bill, those wishing to practice midwifery need tocological certification from a group accredited by the National Organization for Competency Assurance. Among the groups accredited by that organization is the North American Registry of Midwives a fact not mentioned in the legislation. Debbie Pulley of the North American Registry of Midwifes said she's certain her organization meets the bill's requirement of providing tocological certification to prospective midwives. But she admits that even she had to look up the definition of tocology. Loudon credits midwife lobbyists with coming up with a creative provision. "Those midwives are a resourceful bunch," he said. The bill is HB818.